Papers by Damien Giacchero
Journal of the European Academy of Dermatology and Venereology
Editor Kaposi’s varicelliform eruption (KVE) is a distinct cutaneous eruption that arises over a ... more Editor Kaposi’s varicelliform eruption (KVE) is a distinct cutaneous eruption that arises over a pre-existing dermatosis, and is caused by Herpes simplex virus (HSV) type 1 or type 2 and rarely by Coxsackie A16 virus or vaccine virus. The most common predisposing condition for KVE is atopic dermatitis, but KVE is also described in association with papulosquamous or acantholytic dermatosis. Here, we describe the case of a patient with KVE occurring during the treatment of a pityriasis rubra pilaris (PRP). A 62-year-old woman presented to the dermatology unit with a generalized erythematous scaly descending eruption that has been evolving for 15 days. Medical history was otherwise unremarkable. Physical examination revealed an intense scaly scalp involvement with generalized erythroderma with sparing islands and waxy palmoplantar keratodermia. This clinical appearance and histological inputs (Fig. 1) confirmed the diagnosis of erythrodermic PRP, and the patient was started on UVB-TL01 therapy and 25 mg of acitretin (Soriatane ) per day. After 10 days of treatment, the patient developed a painful, febrile and acute facial eruption with monomorphic, umbilicated and grouped vesiculopustular lesions of the face and upper trunk (Fig. 2). Local sampling using direct immunofluorescence revealed the presence of HSV1, and viroculture confirmed HSV1 infection. A treatment with 3 g of oral valaciclovir (Zelitrex ) per day for 10 days induced complete clinical remission. Kaposi’s varicelliform eruption is traditionally described as an acute and generalized syndrome with an important alteration of clinical status and high fever. KVE usually affects patients suffering from atopic dermatitis, but can develop over several other dermatosis: acantholytic dermatosis (pemphigus, Darier’s disease, Hailey–Hailey, etc.), ichtyosis, mycosis fungoides, acute severe burn injuries and rosacea. Psoriasis and PRP share strikingly similar features so that clinical and histological differential diagnosis of both these entities is difficult to perform. KVE rarely occurs in patients with psoriasis and, to our knowledge, an association of cutaneous HSV widespread infection with PRP has only been described once. Although phototherapy is among treatment options for PRP, it has been reported to aggravate PRP, which may have promoted the infection. Moreover, in our reported case, narrow-band UVB therapy diminished
British Journal of Dermatology, 2015
As transformed mycosis fungoides (TMF) large-cells may express CD30 antigen, the differential dia... more As transformed mycosis fungoides (TMF) large-cells may express CD30 antigen, the differential diagnosis between CD30-rich TMF and primary cutaneous anaplastic large cell lymphoma (cALCL) may be difficult, especially to distinguish cALCL associated with MF vs CD30-rich TMF. To find clinical, histological and molecular diagnostic features useful for differential diagnosis between cALCL and CD30-rich TMF. To analyze and compare the prognostic value of clinical and pathological factors in these two diseases. . METHODS: We conducted a retrospective study (1999-2012) of 32 cALCL and 34 CD30-rich TMF, seen in reference centers of the French Study Group of Cutaneous Lymphoma. Clinical, histological and molecular features were analyzed and compared to determine their diagnostic and prognostic value. Comparison of the 2 groups showed that age ˃60, ≥ 5 skin lesions, early progression, absence of spontaneous regression, trunk involvement, were significantly associated with the diagnosis of TMF. Abnormal T-cell phenotype and perforin expression were significantly more frequent in cALCL (both p<0.001). Overall survival (OS) at 5 years was 77.4% for cALCL and 20.7% for CD30-rich TMF. Stage T3, ≥ 5 skin lesions, lower limb involvement for cALCL and stage T4, extracutaneous involvement, B symptoms, high levels of LDH for CD30-rich TMF were associated with poor OS and progression-free survival. DUSP22 rearrangement had no diagnostic or prognostic value. Clinical features and outcome are the most discriminative to differentiate the two entities. Even histological and molecular markers were not fully specific, abnormal vs normal T-cell phenotype and perforin expression may constitute helpful tools. This article is protected by copyright. All rights reserved.
European Journal of Cancer Supplements, 2009
Effect of various patient and treatment related factors on the outcome with respect to xerostomia... more Effect of various patient and treatment related factors on the outcome with respect to xerostomia and dysphagia were analyzed. Results: Fifty one consecutive eligible patients participated in this prospective study. There were 48 males and 3 females (median age 54 years). Median treatment to evaluation time (follow up) for the entire group was 50 months (2−201months). Forty seven patients had received combined EBRT and BRT while 4 patients received BRT alone. EBRT was delivered using standard portals with a median dose of 44 Gy/22 fractions over 4 weeks. BRT was low dose rate in 23 patients and high dose rate in 28 patients. Median dose of BRT was 30 Gy with LDR and 20 Gy with HDR BRT. The median xerostomia score was only 16 (Range: 0−73) suggestive of recovery of the salivary glands. There was no difference in the xerostomia while eating (stimulated) vs at rest (basal) for the entire population. Xerostomia scores in patients treated with LDR BRT vs HDR BRT were comparable. XQ scores compared favorably with published results using the same questionnaire after intensity modulated radiation therapy (IMRT) (Meirovitz 2006). Median dysphagia score was 2.4 (Range 1.4−3) for the entire population indicating good swallowing status post BRT. There was significant correlation between the xerostomia and the dysphagia scores (<0.001). Conclusion: Patient reported xerostomia was consistently low with usage of brachytherapy both at rest (basal) and while eating (stimulated) signifying organ and function preservation. Significant correlation of dysphagia and xerostomia scores suggests that xerostomia and dysphagia are closely interrelated. 8539 POSTER Induction chemotherapy with docetaxel, cisplatin and S-1 (TPS) followed by proton therapy concurrent with cisplatin in the patients with T4 nasal cavity cancer
La Revue de Médecine Interne, 2012
La Revue de Médecine Interne, 2010
Annales de Dermatologie et de Vénéréologie, 2014
Introduction Les cellules tumorales circulantes (CTC) font l’objet d’un interet croissant en onco... more Introduction Les cellules tumorales circulantes (CTC) font l’objet d’un interet croissant en oncologie comme facteur pronostique et marqueur de reponse therapeutique. La detection de CTC par tri immunomagnetique (CellSearch ® ) a fait la preuve de son interet dans le cancer metastatique mammaire et colique. Il n’existe pas de methode validee de detection des cellules de melanome circulantes (CMC). Compte-tenu des avancees therapeutiques recentes dans le domaine du melanome, il est interessant de rechercher si les CMC pourraient servir de marqueur de reponse therapeutique. L’objectif de cette etude etait de determiner l’effet du traitement sur le nombre de CMC chez les patients atteints de melanome metastatique. Materiel et methodes Etude prospective menee au CHU de Nice (service de dermatologie) chez des patients atteints de melanome metastatique. Pour chaque patient, 2 prelevements de 7,5 ml de sang etaient realises ; avant le debut du traitement (M0) et a 2 mois d’un traitement par inhibiteur de BRAF (BRAFi, M2) et a 9 semaines d’un traitement par chimiotherapie (CT) ou ipilimumab (M2,5). Les CMC ete isolees avec un anticorps dirige contre l’antigene de melanome CD146 couple a des billes magnetiques pour ensuite etre identifiees en immunofluorescence et comptees par un analyseur de cellules. Observations Trente patients ont ete inclus. L’analyse a pu etre completee chez 20 patients (deces ; n = 4, problemes techniques ; n = 6). Neuf patients ont ete traites par BRAFi, 6 par CT et 5 par ipilimumab. Tous types de traitements confondus, le nombre moyen de CMC a diminue significativement apres traitement, passant respectivement de 16,55/mL (extremes : 0,0/mL–294,0/mL) a 0,25/mL (extremes : 0,0/mL–5,0/mL, p = 0,015). L’analyse en sous-groupe a revele pour chaque type de traitement une diminution du nombre de CMC entre M0 et M2 ou M2,5 mais non significative. Dans le groupe traite par BRAFi les resultats obtenus etaient a la limite de la significativite, avec une diminution de 2,33/mL (extremes : 0,0/mL–10,0/mL) a 0,0/mL (extremes : 0,0/mL–0,0/mL, p = 0,058). Discussion Il s’agit a notre connaissance de la premiere etude montrant une diminution du nombre de CMC chez des patients traites pour melanome metastatique. L’absence de significativite pour l’analyse en sous-groupe peut s’expliquer par le manque de puissance lie aux faibles effectifs avec toutefois une tendance a la significativite pour le BRAFi. Le suivi des patients est en cours afin de determiner si cette diminution du nombre de CMC est correlee a l’efficacite du traitement. Conclusion Cette etude pilote a permis de montrer pour la premiere fois que la detection de CMC par tri immunomagnetique (CellSearch ® ) etait realisable et que les taux sanguins de CMC diminuaient significativement sous l’effet d’un traitement systemique. L’arrivee de nouveaux outils theranostiques devrait permettre d’optimiser ces resultats.
Journal of the European Academy of Dermatology and Venereology, 2013
Journal of the American Academy of Dermatology, 2014
An 80-year-old woman with a history of palatine nodular melanoma with local recurrences and visce... more An 80-year-old woman with a history of palatine nodular melanoma with local recurrences and visceral metastases suddenly developed widespread small (2-to 5-mm) pink macules on her chest and back (Fig 1). Fig 1. Hypomelanotic cutaneous melanoma metastases. Widespread pink to light brown macules over the patient's back (A), sides (B), chest (C), and abdomen (D).
Journal of Investigative Dermatology, 2013
1999) or the components of the IL-31 receptor might be involved in the pathogenesis of sporadic P... more 1999) or the components of the IL-31 receptor might be involved in the pathogenesis of sporadic PCA. Although additional work is required to translate our current finding to disease management, modulation of MCP-1 level and function, through IL-31dependent and-independent pathways, may offer a new approach for therapeutic development for FPCA.
Journal of Investigative Dermatology, 2010
Journal of Clinical Oncology, 2013
A 68-year-old woman (patient 1) was diagnosed in October 2010 with a melanoma of the back of the ... more A 68-year-old woman (patient 1) was diagnosed in October 2010 with a melanoma of the back of the superficial spreading melanoma subtype, with a Breslow thickness of 1.1 mm. Ulceration and mitoses were not observed. In June 2011, she developed right axillary lymph node metastases that were treated by surgery. In September 2011, the patient developed multiple subcutaneous and pulmonary metastases. A mutation analysis showed no BRAF mutation at position V600 and no NRAS mutations at positions G12 and Q61. Treatment with dacarbazine failed to stop the progression of the subcutaneous and pulmonary metastases. After obtaining informed consent from this patient as well as two additional patients, we isolated melanoma cells from lymph node metastases and studied the extracellular signal-regulated kinase (ERK) signaling pathway in these cells. Used as a control, stem-cell factor induced strong ERK activation in human melanocytes. We observed ERK activation in the cells from patient 2 (BRAF V600E) but no activation in cells from patient 3 (BRAF V600V; Fig 1A; NHM, normal human melanocytes; NT, no treatment; pERK , phosphorylated-ERK; SCF, stem cell factor). Notably, the cells from patient 1 also showed robust ERK activation, although e324
Journal Français d'Ophtalmologie, 2009
ABSTRACT Introduction Le carcinome basocellulaire est une tumeur cutanée à potentiel de malignité... more ABSTRACT Introduction Le carcinome basocellulaire est une tumeur cutanée à potentiel de malignité essentiellement local. Au niveau palpébral, une prise en charge inadaptée est génératrice de récidives compromettant le contrôle tumoral. En 2004, de nouvelles recommandations de l’ANAES ont été établies dans le but de standardiser la prise en charge de cette pathologie. Au cours de cette étude, nous avons voulu établir l’apport de ces recommandations dans la prise en charge des carcinomes basocellulaires des paupières. Matériels et Méthodes Nous avons réalisé une étude rétrospective sur une cohorte de 20 patients ayant présenté un carcinome basocellulaire des paupières. Le traitement a consisté en une chirurgie d’exérèse avec analyse histologique suivie d’une reconstruction palpébrale. Discussion les voies d’amélioration de la chirurgie d’exérèse des tumeurs palpébrales, comme l’examen extemporané des pièces opératoires et la chirurgie micrographique de Mohs visent à diminuer le taux de récidive locale. Cependant, il n’existe pas actuellement de consensus sur les marges latérales à appliquer. Ceci provoque une grande hétérogénéité de la prise en charge, en particulier dans certaines formes cliniques comme les tumeurs du tiers interne palpébral. Conclusion Nous proposons une réflexion sur la prise en charge des carcinomes basocellulaires des paupières prenant en compte les spécificités induites par la localisation palpébrale.
Clinical Oncology, 2011
[1] Maubec E, Duvillard P, Velasco V, Crickx B, Avril MF. Immunohistochemical analysis of EGFR an... more [1] Maubec E, Duvillard P, Velasco V, Crickx B, Avril MF. Immunohistochemical analysis of EGFR and HER-2 in patients with
British Journal of Dermatology, 2010
Archives of Dermatology, 2012
RESEARCH LETTERS A New Spectrum of Skin Toxic Effects Associated With the Multikinase Inhibitor V... more RESEARCH LETTERS A New Spectrum of Skin Toxic Effects Associated With the Multikinase Inhibitor Vandetanib S kin manifestations are among the most frequent adverse effects of targeted therapies. 1 Hyperkeratosis and hand-foot skin reaction are observed with most raf and vascular endothelial growth factor (VEGF) inhibitors, whereas folliculitis is a hallmark of epidermal growth factor receptor (EGFR) blocking agents. 1 Vandetanib (Zactima, ZD6474; AstraZeneca) is a multikinase inhibitor that targets EGFR, VEGF receptors 1, 2, and 3 and the RET (rearranged during transfection) receptor. 2 Methods. Between November 2005 and October 2009, patients with metastatic thyroid cancer received vandetanib at a dose of 300 mg/d in 3 clinical trials: a phase 2 open-label study (NCT00098345) 3 and 2 randomized phase 3 studies comparing vandetanib with a placebo (NCT00537095 and NCT00410761). Clinical examination of all patients exhibiting any skin manifestation was performed. Skin toxic effects were assessed using version 3 of the National Cancer Institute Common Terminology Criteria (http://ctep.cancer.gov/protocolDevelopment /electronic_applications/ctc.htm), and additional drug intake was recorded. All patients participating in this study provided a written informed consent for the clinical trials. This study was conducted according to the Declaration of Helsinki Good Clinical Practice guidelines and in accordance with applicable local laws and regulations. Methods. Patients with MF and SS who underwent FDG-PET/CT scans (Gemini TOF 64 slice PET/CT scanner; Philips Healthcare Inc) either at the time of diagnosis or at the time of suspected relapse or progression over a 4-year period at our cutaneous lymphoma clinic were retrospectively enrolled in this study. Twenty patients (stage IA-IB) did not undergo PET/CT scans because patients
Annales de Dermatologie et de Vénéréologie, 2007
Annales de Dermatologie et de Vénéréologie, 2006
Annales de Dermatologie et de Vénéréologie, 2012
Annales de Dermatologie et de Vénéréologie, 2012
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Papers by Damien Giacchero